Cigarrillo electrónico y otros sistemas electrónicos de liberación de nicotina

revisión de evidencias sobre un tema controversial

  • Laura Llambí Uruguay, Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Clínica Médica “A”, Unidad de Tabaquismo, Internista.
  • Diego Rodríguez Uruguay, Centro de Investigación para la Epidemia del Tabaquismo, Sociólogo.
  • Enrique Soto Uruguay, Ministerio de Salud Pública, Programa Nacional para el Control de Tabaco, Cardiólogo.
  • Carolina Parodi Uruguay, Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Clínica Médica “A”, Unidad de Tabaquismo, Internista.
Palabras clave: CIGARRILLO ELECTRÓNICO, VAPEO, SISTEMAS ELECTRÓNICOS DE LIBERACIÓN DE NICOTINA, TABAQUISMO, CESE DEL HÁBITO DE FUMAR

Resumen

Introducción: los cigarrillos electrónicos (CE) son sistemas que liberan aerosol conteniendo nicotina y otras sustancias. Desde su aparición han generado una gran controversia en la comunidad científica dedicada al control de tabaco, existiendo evidencias que los posicionan como una alternativa de tratamiento para la cesación tabáquica y otros estudios que muestran sus daños a la salud, así como convertirlos en la puerta de entrada a los jóvenes a la adicción a nicotina.
Objetivo: recopilar evidencia disponible sobre CE con referencia a componentes, riesgos para la salud, cesación de tabaquismo, impacto poblacional y aspectos normativos y regulatorios.
Método: revisión narrativa. Se realizó búsqueda bibliográfica en bases PubMed, MEDLINE, SCOPUS, Redalyc, SciELO, LiLACS, Dialnet, ScienceDirect, así como en documentos de la Organización Mundial de la Salud, sociedades científicas, sitios web dedicados a consumidores y legislación nacional e internacional.
Resultados: se revisaron 130 documentos, de los cuales se toman los 63 más relevantes. Existen evidencias científicas sobre contenidos tóxicos y carcinógenos en líquidos y aerosoles de los CE, así como de daño a la salud cardiovascular y respiratoria. Se presentan estudios controversiales sobre su eficacia para dejar de fumar. Se presenta evidencia acerca de cómo los CE impactan negativamente en la iniciación de jóvenes al consumo y en la recaída de exfumadores. Se analiza la normativa nacional e internacional para regular los CE.
Conclusiones: los profesionales de la salud no deben aconsejar el uso de CE, dado que no son seguros y exponen a los consumidores y a la población en general de los efectos deletéreos directos e indirectos de los CE.

Citas

(1) World Health Organization. Conference of the Parties to the WHO Framework Convention on Tobacco Control. Electronic nicotine delivery systems and electronic non-nicotine delivery systems (ENDS/ENNDS). Report by WHO. 2016; (FCTC/COP/7/11, August 2016). Disponible en: https://www.who.int/fctc/cop/cop7/FCTC_COP_7_11_EN.pdf?ua=1&ua=1 [Consulta: mayo 2019].
(2) Centers for Disease Control and Prevention. Electronic cigarettes, 2018. Disponible en: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/index.htm [Consulta: mayo 2019].
(3) International Tobacco Control Policy Evaluation Project. ITC Uruguay national report. Findings from the wave 1 to 4 surveys (2006-2012). 2014. Disponible en: http://www.itcproject.org/files/ITC_Uruguay_Report-English-Sept24v24.pdf [Consulta: mayo 2019].
(4) Llambí L, Parodi C, Barros M, Sevillano P, Pereira M, Sandberg M, et al. Cigarrillo electrónico y pipas de agua: conocimientos y uso entre estudiantes de Medicina, Uruguay, 2015. Rev Urug Med Int 2016; 1(3):76-83.
(5) Uruguay. Ministerio de Salud Pública. Encuesta Mundial de Tabaco en Adultos-Global Adult Tobacco Survey. 2017.
(6) World Health Organization. Conference of the Parties to the WHO Framework Convention on Tobacco Control Electronic nicotine delivery systems. Report by WHO. 2014; (FCTC/COP/6/10, 21 July 2014). Disponible en: http://apps.who.int/gb/fctc/PDF/cop6/FCTC_COP6_10-en.pdf [Consulta: mayo 2019].
(7) Bam TS, Bellew W, Berezhnova I, Jackson-Morris A, Jones A, Latif E, et al. Position statement on electronic cigarettes or electronic nicotine delivery systems. Int J Tuberc Lung Dis 2014; 18(1):5-7.
(8) Álvarez R. Quién es JUUL y por qué los dueños de Philip Morris, fabricantes de Marlboro, están invirtiendo 12.800 millones en ella. 2019. Disponible en: www.xataka.com/medicina-y-salud/quien-juul-que-duenos-philip-morris-fabricantes-marlboro-estan-invirtiendo-12-800-millones [Consulta: mayo 2019].
(9) Solovapeamos. Disponible en: http://www.solovapeamos.com/ [Consulta: mayo 2019].
(10) Altet Gómez MN. Los cigarrillos electrónicos: “vapear’’, un nuevo riesgo para los adolescentes (Revisión). Docplayer 2014. Disponible en: https://docplayer.es/12701933-Revision-los-cigarrillos-electronicos-vapear-un-nuevo-riesgo-para-los-adolescentes-maria-nieves-altet-gomez.html [Consulta: mayo 2019].
(11) Palazzolo DL. Electronic cigarettes and vaping: a new challenge in clinical medicine and public health. A literature review. Front Public Health 2013; 1:56.
(12) Orellana-Barrios MA, Payne D, Mulkey Z, Nugent K. Electronic cigarettes-a narrative review for clinicians. Am J Med 2015; 128(7):674-81.
(13) Bertholon JF, Becquemin MH, Annesi-Maesano I, Dautzenberg B. Electronic cigarettes: a short review. Respiration 2013; 86(5):433-8.
(14) Saffari A, Daher N, Ruprecht A, De Marco C, Pozzi P, Boffi R, et al. Particulate metals and organic compounds from electronic and tobacco-containing cigarettes: comparison of emission rates and secondhand exposure. Environ Sci Process Impacts. 2014; 16(10):2259-67.
(15) Pisinger C. A systematic review of health effects of electronic cigarettes. 2015 (Document prepared for the World Health Organization, December 2015). Disponible en: https://www.who.int/tobacco/industry/product_regulation/BackgroundPapersENDS3_4November-.pdf?ua=1 [Consulta: mayo 2019].
(16) Jiménez Ruiz CA, Solano Reina S, de Granda Orive JI, Signes-Costa Minaya J, de Higes Martinez E, Riesco Miranda JA, et al. El cigarrillo electrónico. Declaración oficial de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR) sobre la eficacia, seguridad y regulación de los cigarrillos electrónicos. Arch Bronconeumol 2014; 50(8):362-7.
(17) Soule EK, Maloney SF, Spindle TR, Rudy AK, Hiler MM, Cobb CO. Electronic cigarette use and indoor air quality in a natural setting. Tob Control 2017; 26(1):109-12.
(18) Williams M, Villarreal A, Bozhilov K, Lin S, Talbot P. Metal and silicate particles including nanoparticles are present in electronic cigarette cartomizer fluid and aerosol. PLoS One 2013; 8(3):e57987.
(19) Lee WH, Ong SG, Zhou Y, Tian L, Bae HR, Baker N, et al. Modeling cardiovascular risks of e-cigarettes with human-induced pluripotent stem cell–derived endothelial cells. J Am Coll Cardiol 2019; 73(21):2722-37.
(20) Vindhyal MR, Ndunda P, Munguti C, Vindhyal S, Okut H. Impact on cardiovascular outcomes among e-cigarette users: a review national health interview surveys. J Am Coll Cardiol 2019; 73(9 suppl 2):11.
(21) Ndunda PM, Muutu TM. Electronic cigarette use is associated with a higher risk of stroke. Stroke 2019; (Suppl 1):A9.
(22) Vardavas CI, Anagnostopoulos N, Kougias M, Evangelopoulou V, Connolly GN, Behrakis PK. Short-term pulmonary effects of using an electronic cigarette: impact on respiratory flow resistance, impedance, and exhaled nitric oxide. Chest 2012; 141(6):1400-6.
(23) Li D, Sundar IK, Mcintosh S, Ossip DJ, Goniewicz ML, O’Connor RJ, et al. Association of smoking and electronic cigarette use with wheezing and related respiratory symptoms in adults: cross-sectional results from the Population Assessment of Tobacco and Health (PATH) study, wave 2. Tob Control 2019. doi: 10.1136/tobaccocontrol-2018-054694.
(24) Moretto N, Volpi G, Pastore F, Facchinetti F. Acrolein effects in pulmonary cells: relevance to chronic obstructive pulmonary disease. Ann N Y Acad Sci 2012; 1259:39-46.
(25) McCauley L, Markin C, Hosmer D. An unexpected consequence of electronic cigarette use. Chest 2012; 141(4):1110-3.
(26) Glantz SA, Bareham DW. E-cigarettes use, effects on smoking, risks, and policy implications. Annu Rev Public Health 2018; 39:215-35.
(27) U.S. Food & Drug Administration. Some e-cigarette users are having seizures, most reports involving youth and young adults. 2019. Disponible en: https://www.fda.gov/tobacco-products/ctp-newsroom/some-e-cigarette-users-are-having-seizures-most-reports-involving-youth-and-young-adults [Consulta: mayo 2019].
(28) Brownson EG, Thompson CM, Goldsberry S, Chong HJ, Friedrich JB, Pham TN, et al. Explosion injuries from E-Cigarettes. N Engl J Med 2016; 375:1400-2. doi: 10.1056/NEJMc1608478.
(29) Burstyn I. Peering through the mist: systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks. BMC Public Health 2014; 14:18.
(30) Bullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J, et al. Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet 2013; 382(9905):1629-37.
(31) Caponnetto P, Campagna D, Cibella F, Morjaria JB, Caruso M, Russo C, et al. EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as tobacco cigarettes substitute: a prospective 12-month randomized control design study. PLoS One 2013; 8(6):1-12.
(32) Hartmann-Boyce J, McRobbie H, Bullen C, Begh R, Stead LF, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev 2016; 9:CD010216.
(33) Tseng TY, Ostroff JS, Campo A, Gerard M, Kirchner T, Rotrosen J, et al. A randomized trial comparing the effect of nicotine versus placebo electronic cigarettes on smoking reduction among young adult smokers. Nicotine Tob Res 2016; 18(10):1937-43.
(34) Carpenter MJ, Heckman BW, Wahlquist AE, Wagener TL, Goniewicz ML, Gray KM, et al. A naturalistic, randomized pilot trial of E-cigarettes: uptake, exposure, and behavioral effects. Cancer Epidemiol Biomarkers Prev 2017; 26(12):1795-803.
(35) Halpern SD, Harhay MO, Saulsgiver K, Brophy C, Troxel AB, Volpp KG. A pragmatic trial of e-cigarettes, incentives, and drugs for smoking cessation. N Engl J Med 2018; 378(24):2302-10.
(36) Hajek P, Phillips-Waller A, Przulj D, Pesola F, Myers Smith K, Bisal N, et al. A randomized trial of e-cigarettes versus nicotine-replacement therapy. N Engl J Med 2019; 380(7):629-37.
(37) Bullen C, Verbiest M, Galea-Singer S, Kurdziel T, Laking G, Newcombe D, et al. The effectiveness and safety of combining varenicline with nicotine e-cigarettes for smoking cessation in people with mental illnesses and addictions: study protocol for a randomised-controlled trial. BMC Public Health 2018; 18(1):596.
(38) Klonizakis M, Crank H, Gumber A, Brose LS. Smokers making a quit attempt using e-cigarettes with or without nicotine or prescription nicotine replacement therapy: impact on cardiovascular function (ISME-NRT)-a study protocol. BMC Public Health 2017; 17(1):293.
(39) World Health Organization. Conference of the Parties to the WHO Framework Convention on Tobacco Control. Progress report on regulatory and market developments on electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS). Report by the Convention Secretariat. 2018; (FCTC/COP/8/10, 27 June 2018). Disponible en: https://www.who.int/fctc/cop/sessions/cop8/FCTC_COP_8_10-EN.pdf?ua=1 [Consulta: mayo 2019].
(40) Velázquez Benítez D, Friman Rodríguez N, González García M. Programas de reducción de daños en las adicciones, un dilema ético. CCM 2016; 20(4):804-9.
(41) Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel, Liaisons, and Staff. Treating tobacco use and dependence?: 2008 update. Rockville (MD): US Department of Health and Human Services; 2008.
(42) Uruguay. Ministerio de Salud Pública. Programa Nacional para el Control del Tabaco. Guía nacional para el abordaje del tabaquismo Uruguay 2009. Montevideo: MSP, 2009.
(43) U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. The Health consequences of smoking-50 years of progress: a report of the Surgeon General. Atlanta, GA: CDC, 2004.
(44) Mcneill A, Brose LS, Calder R, Hitchman SC, Hajek P, McRobbie H. E-cigarettes: an evidence update. A report commissioned by Public Health England. London: Public Health England, 2015. Disponible en: www.gov.uk/government/uploads/system/uploads/attachment_data/file/454516/Ecigarettes_an_evidence_update_A_report_commissioned_by_Public_Health_England.pdf [Consulta: mayo 2019].
(45) Bauld L, McNeill A, Hajek P, Britton J, Dockrell M. E-cigarette use in public places: striking the right balance. Tob Control 2017; 26(e1):e5-6.
(46) Nutt DJ, Phillips LD, Balfour D, Curran HV, Dockrell M, Foulds J, et al. Estimating the harms of nicotine-containing products using the MCDA approach. Eur Addict Res 2014; 20(5):218-25.
(47) Lindson-Hawley N, Hartmann-Boyce J, Fanshawe TR, Begh R, Farley A, Lancaster T. Interventions to reduce harm continued tobacco use. Cochrane Database Syst Rev 2016; (10): CD005231.
(48) Feirman SP, Lock D, Cohen JE, Holtgrave DR, Li T. Flavored tobacco products in the United States: a systematic review assessing use and attitudes. Nicotine Tob Res 2016; 18(5):739-49.
(49) Dutra LM, Glantz SA. Electronic cigarettes and conventional cigarette use among US adolescents: a cross-sectional study. JAMA Pediatr 2014; 168(7):610-7.
(50) Brown J, Beard E, Kotz D, Michie S, West R. Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study. Addiction 2014; 109(9):1531-40.
(51) Beard E, West R, Michie S, Brown J. Association between electronic cigarette use and changes in quit attempts, success of quit attempts, use of smoking cessation pharmacotherapy, and use of stop smoking services in England: time series analysis of population trends. BMJ 2016; 354:i4645.
(52) Christensen T, Welsh E, Faseru B. Profile of e-cigarette use and its relationship with cigarette quit attempts and abstinence in Kansas adults. Prev Med 2014; 69:90-4.
(53) Al-Delaimy WK, Myers MG, Leas EC, Strong DR, Hofstetter CR. E-cigarette use in the past and quitting behavior in the future: A population-based study. Am J Public Health 2015; 105(6):1213-9.
(54) Sutfin EL, Reboussin BA, Debinski B, Wagoner KG, Spangler J, Wolfson M. The impact of trying electronic cigarettes on cigarette smoking by college students: a prospective analysis. Am J Public Health 2015; 105(8):e83-9.
(55) Kalkhoran S, Glantz SA. E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis. Lancet Respir Med 2016; 4(2):116-28.
(56) Soule EK, Plunk AD, Harrell PT, Hayes RB, Edwards KC. Longitudinal analysis of associations between reasons for electronic cigarette use and change in smoking status among adults in the Population Assessment of Tobacco and Health Study. Nicotine Tob Res 2019. doi: 10.1093/ntr/ ntz005.
(57) Hallingberg B, Maynard OM, Bauld L, Brown R, Gray L, Lowthian E, et al. Have e-cigarettes renormalised or displaced youth smoking? Results of a segmented regression analysis of repeated cross sectional survey data in England, Scotland and Wales. Tob Control 2019; 1-10.
(58) Pisinger C, Godtfredsen N, Bender AM. A conflict of interest is strongly associated with tobacco industry-favourable results, indicating no harm of e-cigarettes. Prev Med 2019; 119:124-31.
(59) Martínez C, Fu M, Galán I, Pérez-Rios M, Martínez-Sánchez JM, López MJ, et al. Conflicts of interest in research on electronic cigarettes: a cross-sectional study. Tob Induc Dis 2018; 16:28. doi:10.18332/tid/90668.
(60) Yoong SL, Stockings E, Chai LK, Tzelepis F, Wiggers J, Oldmeadow C, et al. Prevalence of electronic nicotine delivery systems (ENDS) use among youth globally: a systematic review and meta-analysis of country level data. Aust N Z J Public Health 2018; 42(3):303-8.
(61) Research and marketing. Electronic cigarette market by product type, flavor and distribution channel - global opportunity analysis and industry forecast, 2017-2023. Disponible en: https://www.researchandmarkets.com/research/pjkd84/global_electronic?w=5 [Consulta: mayo 2019].
(62) OMS. Conferencia de las Partes en el Convenio Marco de la OMS para el Control del Tabaco. Informe sobre los progresos normativos y de mercado en materia de sistemas electrónicos de administración de nicotina (SEAN) y sistemas electrónicos sin nicotina (SESN). Informe de la Secretaría del Convenio. 2018; (FCTC/COP/8/1, 27de junio de 2018).
(63) Uruguay. Poder Ejecutivo. Decreto 534/009. Protección del derecho al medio ambiente libre de humo de tabaco y su consumo. Disponible en: https://www.impo.com.uy/bases/decretos/534- 2009 [Consulta: mayo 2019].
(64) Uruguay. Poder Ejecutivo. Decreto 299/017. Modificación del art. 1° del decreto 534/009, relativo a la comercialización, importación, registro como marca o patente y publicidad de cualquier dispositivo electrónico para fumar. Disponible en: https://www.impo.com.uy/bases/decretos/299-2017 [Consulta: mayo 2019].
Cómo citar
1.
Llambí L, Rodríguez D, Soto E, Parodi C. Cigarrillo electrónico y otros sistemas electrónicos de liberación de nicotina. Rev. Méd. Urug. [Internet]. 1 [citado 23 de abril de 2024];36(1):59-3. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/502
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